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MONTREAL – Do nicotine replacement therapies really work? Some smokers seem to have been able to quit with the help of these products, while others have failed to break the habit despite their use. This edition of Healthwatch examines a newly released study, a systematic review of existing research that looks at the effectiveness of different nicotine replacement therapies.

Smoking kills

Not only is nicotine one of Canada's most addictive drug, tobacco is its biggest killer. One in two of all long-term smokers will die as a consequence of smoking, and one in five of all deaths in Canada are attributable to this habit. Death and smoking-related illnesses come in the form of heart attacks and strokes, as well as emphysema and many forms of cancer.

A 2007 Health Canada report states that almost 5 million people - roughly 18 per cent of Canadians over 15 - are smokers, with an average consumption of roughly 15 cigarettes per day. What's more, the population most at risk for taking up smoking is the 15- to 24-year-old age group.

Understanding nicotine addiction

Nicotine acts as a mood stabilizer, or enhancer, by boosting certain chemicals in the brain that produce a "high." The aim of nicotine replacement therapy, therefore, is to replace much of the nicotine produced by cigarettes, and to reduce cigarette cravings and withdrawal symptoms. Nicotine is relatively safe over the long-term; it is the other toxic compounds in cigarette smoke that are not.

How does nicotine replacement therapy work?

All forms of nicotine replacement therapy mimic the release of these "feel good" chemicals, and keep withdrawal symptoms in check by maintaining steady chemical levels. The therapy lessens the unpleasant effects of nicotine withdrawal while the person adapts to not smoking. It is meant as a bridge to abstinence, the ultimate goal of all smoking cessation products.

Four therapies are currently available in Canada without a prescription: chewing gum, lozenges placed under the tongue, inhalers, and the transdermal patch. While the patch provides the brain a steady level of nicotine, the other methods deliver it more quickly and may better counter the well-known cravings that the quitting smoker can experience.

This Cochrane Review examined 132 trials of nicotine replacement therapy, with more than 40,000 people in the main analysis. The review found evidence that all forms of nicotine replacement therapy made it more likely that a person's attempt to quit smoking would succeed.

Specifically, nicotine replacement therapy was shown to increase a person's chances of quitting by 50 to 70 per cent. The studies in the review were performed largely in smokers who were offered nicotine replacement therapies by their family doctor or who applied to quitting programs. Most of the studies were performed in people smoking more than 15 cigarettes a day and thus had high levels of nicotine dependence.

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The review showed that rapid nicotine delivery methods (gum, lozenges and inhalers) were generally more effective than the patch. They also found that combining a nicotine patch with one of the more rapid delivery forms of nicotine replacement therapy was more effective than a single type of therapy alone.

Other conclusions included there was no benefit in using the patch beyond eight weeks. And wearing the patch only during waking hours (16 hours a day) was shown to be as effective as wearing it 24 hours a day.

Interestingly, there is no evidence that tapered therapy is better than abrupt withdrawal. There is weak evidence that a repeated course of therapy in patients who have relapsed after recent use of nicotine patches will result in additional probability of quitting.

Does behavioral counselling and support affect nicotine replacement therapy?

An important finding was that nicotine replacement therapy works equally well with or without the addition of counselling. Joining a support program, which increases the likelihood of quitting, is not essential to the success of nicotine replacement therapy.

So, what's the bottom line for smokers?

Nicotine dependence, like alcoholism, is a disease that takes a huge toll on smokers and their families. Quitting is really tough, however, with actual success rates per attempt ranging in the 10- to 15-per-cent range; most smokers need four to seven tries before finally succeeding.

With this in mind, persistence and constant encouragement are the key. After making the decision to quit, getting nicotine replacement therapy may be the single most important step a smoker can take on the road to improved health.

Both the patch and the gum are covered by the Quebec provincial health plan, while the lozenges and inhaler are not, since they're newer than the other forms of therapy and don't have the same track record. The provincial government will, however, cover the cost of any nicotine replacement therapy for a consecutive 12-week period within one year. Most private insurance companies will also reimburse the cost of the patch and the gum.

A seven-day supply of transdermal patches costs $30; 105 tablets of gum are priced at $30; the daily consumption of the gum is at the discretion of the individual smoker. Ninety-six lozenges - two weeks' worth - cost $34.29 (at least eight per day, to a maximum of 15 per day is the recommended daily regimen). Forty-two inhaler cartridges - a seven-day supply - are priced at $39.99 (prices may vary between stores).

HealthWatch acknowledges the input of Atul Kapur, president of Physicians for a Smoke-Free Canada.

The material provided in HealthWatch is designed for general educational purposes only and does not pertain to individual cases. The information included should not replace necessary medical consultations with your own doctor or medical professional.

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Start out easy, experts say

Milan Khara, an addiction specialist with Vancouver Coastal Health, states: "For smokers attempting to quit, the morning cigarette is the most difficult to give up. The first cigarette of the day is often the most satisfying cigarette for smokers who have a moderate to high level of nicotine dependence because they are combatting withdrawal symptoms by restoring levels of nicotine in their system lost while sleeping.

So, don't start there. Start with the cigarette that is the easiest to give up. Try smoking one less for one day. The Reduce to Quit program using nicotine replacement chewing gum is promoted by Health Canada - it encourages smokers who are trying to quit to replace that cigarette and counter the cravings that they might otherwise experience. Reducing cigarette consumption can also boost a smoker's confidence and motivation to quit successfully by breaking down addictive behavioral patterns and disassociating environmental cues that can trigger cigarette cravings.

Almost Done!

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I also accept and agree to be bound by Postmedia's Terms and Conditions with respect to my use of the Site and I have read and understand Postmedia's Privacy Statement. I consent to the collection, use, maintenance, and disclosure of my information in accordance with the Postmedia's Privacy Policy.